Financial study of endoscopic band ligation without resection (with SINK biopsy) application in≤10-mm digestive tract subepithelial tumors: exponential cost-effective strategy

Aims Small subepithelial tumours (SET) require endoscopic surveillance. PMID 37263361 study revealed that endoscopic band ligation without resection (EBL), combined with single-incision needle-knife (SINK) biopsy, led to a change in clinical management in 92.7% of≤10-mm SETs. Aims: to assess the financial impact EBL+SINK strategy implementation would offer through a cost comparison analysis, as well as the impact on the number of annual procedures to be performed (EFI-BANDING-SET study).

Methods Comparison of the conventional management strategy for SETs≤10-mm (with endoscopic surveillance every two years: alternating conventional upper digestive endoscopy [UGE] at the 1st-3rd-5th, etc... controls with endoscopic ultrasonography [EUS] at 2nd-4th-6th, etc… procedures) vs. the proposed EBL+SINK strategy. Fees for endoscopic procedures have been referred from PMID 29610018, updated to 2024 according to the evolution of the Spanish Gross National Product (2018–>2024:+19.2%).

Results Procedural amounts: UGE €100.74; EUS €360.70; EBL+SINK €777.57 (taking into account an adverse event rate of 4.9% [reported in PMID 37263361]). Model assumption: continuous inclusion of one nonspecific≤10-mm SET each year, in≤65 years patient. For each≤10-mm SET with the proposed strategy application (EBL+SINK), compared to the conventional endoscopic follow-up strategy (UGE/EUS every 2 years): from the 2nd direct year onwards, and the 3rd global-cumulative, there is a savings in the number of endoscopic procedures to be performed, with the trend of exponential evolution (5th year: -1.76 procedures; 10th year: -14.11 procedures; 15th year: -38.59 procedures). From the 6th direct year, and the 11th global-cumulative, the direct costs between strategies are beneficiaries, with the subsequent trend being of exponential progressive savings (5th year:+€1,685.51; 10th year: + €857.81; 15th year: -€2,636.65).

Conclusions EBL combined with SINK biopsy in≤10-mm SETs entails, from the 2nd direct year, and the 3rd global-cumulative, an exponential reduction in the number of endoscopic procedures to be performed annually. The strategy is cost-effective, with a progressive savings of direct resources from year 6 onwards, and from 11th global-cumulative year [1] [2].

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Bas-Cutrina F, Loras C, Pardo A, Ballester-Clau R, Huertas C, Guarner-Argente C. et al. Management of small subepithelial tumors by endoscopic banding without resection and single-incision needle-knife-assisted biopsy sampling: a prospective multicenter study. Gastrointest Endosc 2023; 98: 911-21
• 2 Loras C, Mayor V, Fernández-Bañares F, Esteve M.. Study of the standard direct costs of various techniques of advanced endoscopy. Comparison with surgical alternatives. Dig Liver Dis 2018; 50: 689-97